Basic Information
| Provider Information | |||||||||
| NPI: | 1003116476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | SHEYNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 NATURE WALK PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320925073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042307761 | ||||||||
| FaxNumber: | 9042307763 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 NATURE WALK PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320925073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042307761 | ||||||||
| FaxNumber: | 9042307763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2010 | ||||||||
| LastUpdateDate: | 11/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 22360 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.